Juozas Kapturauskas, Edmundas Širvinskas
Bleeding remains a global problem in cardiac surgery. Patients have significant risk of bleeding after cardiac surgery with cardiopulmonary bypass.
The amount of blood loss after such operations is directly related to the increased need of blood transfusion, prolonged hospital stay, worse outcome.
The aim: to identify factors which lead to the increased chest tube drainage during the first postoperative day after aortocoronary bypass grafting; the volume of blood component transfusion, complications and outcomes; evaluate characteristics of postoperative course in patients over 65 years old.
Methodology: a prospective randomized study included 51 patients undergoing isolated aortocoronary bypass grafting surgery in our hospital. Results. During the postoperative period two patients died (3.9%). Complicated course was identified in 16 patients (31.3%). Pneumonia (10 cases, 9.8%), sternal wound infection (5 cases, 4.9%), mediastinitis (2 cases, 3.9%) were the most common complications. One patient was re-explored because of bleeding. Blood component transfusion was performed in three patients at the intensive care unit (5.9%) and in eight patients after the discharge from the intensive care unit. Mechanical ventilation time, intensive care unit stay and hospitalization time was significantly higher in older patients group, however there was no increased requirement for transfusions of blood components. Patients, who preoperatively received clopidogrel (n=21), had higher risk of significant blood loss during the first postoperative day (>500ml) (odds ratio 3.692 [1059-12874], p = 0.036) than the patients without clopidogrel preoperatively (n = 28) (odds ratio, OR 0.271 [0078-0944]). Chest tube drainage did not exceed 500 ml per 16 hours, if clopidogrel was stopped for 6 days or more, but it was 500 ml and higher if clopidogrel was stopped 1 to 5 days preoperatively. Aspirin had no statistically significant influence on chest tube drainage as well as to blood transfusion.
Conclusions. Patients who were treated with clopidogrel before the surgery, had a higher risk of bleeding more than 500 ml first postoperative day, than clopidogrel untreated patients. Chest tube drainage was inversely proportional to the stop time of clopidogrel. Aspirin did not affect the volume, excreted through the drains and the rate of blood components transfusion. The study did not show us, that preoperative fibrinogen level is independent factor to assess bleeding. Patients over 65 years had increased risk for a longer mechanical ventilation, longer intensive care unit stay, hospitalization and higher frequency of complications during postoperative period, but this was not related to increased chest tube drainage or blood components transfusion.
Keyword(s): heart surgery, CPB, bleeding, chest tube drainage, hemostasis
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